Unfogged Eyes

The end of a two-decade vision block

Illustration by Kain Kaiyala

Story by Joshua Grambo

Kicking, screaming, yelling, flailing: a classic tantrum. In my defense, I was 5 years old.

I’m Joshua Grambo, and this outburst was one of many. Taking my eye drops? That hurt, and my 5-year-old self was certain that meant it shouldn’t happen. The eye drops were part of the treatment for my cataracts — imperfections in the lenses of my eyes, like a cloudy camera lens. Cataracts are the reason for about a third of all blindness, according to a 2015 study from the Investigative Ophthalmology & Visual Science journal (IOVS). I was lucky enough to avoid blindness, though. Yay me!

Take a look at a wooden table. You can see the grain, the pattern and all the hues that make up the wood. If you were seeing through my eyes, however, you’d see its general color and could maybe make out the grain, but not much more.

Most cataracts appear in older individuals. Research from the National Eye Institute shows that about a quarter of people between the ages of 65 and 69 have cataracts, increasing to nearly half the population in the 75 to 79 age demographic. Rarely, a person is born with cataracts — like me. Three to four children per 10,000 are born with cataracts, according to a 2003 study on the subject published in the Ophthalmic Epidemiology journal. Isn’t that great? I’m rare.

The white dots in my pupils were a mystery to my parents at first. “You’re my fourth kid, and this is the only thing that was unusual about any of my kids medically, so it was kind of a new experience for me,” said Gillian Grambo, my mother.

After further study, the specks were identified as cataracts, and another doctor recommended removing them surgically. “He was like kind of excited and eager and like, ‘Well, now that we have the eye drops in, we have you here, why don’t we do the surgery now?’” Gillian said. “And we’re like, ‘Wait a second, we need a second opinion, this is too fast.’”

About 7.5% of surgeries on people under 17 resulted in glaucoma, another potentially crippling eye condition, according to a 2008 IOVS study. For children who underwent surgery before they were 9 months old — as I would have been — the risk was a whopping 32%.

For reference, that's about the same likelihood as flipping five coins and getting three heads — not odds my parents were keen to gamble on. Seeking a second opinion, they met with Dr. Avery Weiss, head of ophthalmology at Seattle Children’s Hospital. He recommended against surgery, noting how my cataracts wouldn’t cause total blindness and could be treated with glasses and dilating eye drops. Therefore, surgery — and its inherent risk — wasn’t necessary.

The eye drops dilated my pupils — the same process that happens when eyes adjust to a dark room. My pupils would absorb more light, thus helping me see a bit better. “He said, ‘If this were my child, I would not do surgery,’ which was more convincing to me than the eager approach,” said Gillian.

Now, if you didn’t pick up on it earlier, I’m sad to tell you that I wasn’t a particularly cooperative kid regarding my eye drops. “You hated them; they were very stingy, and it was very stressful trying to give you the drop, so I think I was a little bit avoiding it,” said Gillian. She sought advice from a friend and got a tip: she should just sit on me to administer them. “You know, it wasn’t fun, but you never cried anymore,” she said.

Although I wish I’d cooperated, I can’t deny that I still caused problems, especially when I was young. For years, if I learned my mom planned to give me my eye drops, I’d start running, hiding and doing everything I could to avoid it. Once I was caught, I’d enter into a titanic struggle to escape the sting of dilating my eyes. Sometime around age 7, though, I did learn to control myself. Frankly, it took longer than it should have.

Since birth, I’ve been “the kid with glasses.” As a baby, my glasses made people pay attention to me — supposedly I was adorable. As a teenager, it gave me something unique about myself to latch onto; I had a unique experience I could talk about with my friends, something special to set me apart. Having cataracts impacted all aspects of my life, and it became a cornerstone of who I was.

Even with the eye drops and the glasses, my vision wasn’t great. I always had major issues with light sensitivity — issues so bad I couldn’t even go outside on sunny afternoons. Overcast weather is still my favorite, and I can trace this back to the eye pain caused by bright sunlight.

Toward the end of the day, my drops would wear off, and if my environment was dimly lit, things would get hazy. Shadows were more pronounced, and I’d struggle to focus my eyes on anything specific. I‘ve always loved reading, but it was a struggle when I didn’t have my drops in. Plus, my right eye barely functioned. The cataract there was significantly worse, and since I was born with it, my brain didn’t have the structures necessary to see from that eye. I never developed those structures, and I probably have myself to blame for that.

Around age 5, I was given eye patches to wear over my left eye — my good eye. These would force me to look through my right eye, hopefully forcing my brain to adapt and assemble whatever neurons I needed to see out of it. Yet, the patches would never stay on for long. It was like wearing a blindfold. I could barely see with my uncovered eye, so the instant a sliver of light made its way past the patch on my good eye, I’d use that sliver to see. I’d scratch, rub and tug at the patch, the sliver would grow, and I’d eventually pull it off entirely. This was probably an early symptom of the ADHD I was diagnosed with a decade later.

We eventually stopped patching. Without consistency, the patches weren’t helping, and I was getting too old — the venerable age of 12 — for my brain to adapt. So, life continued. I’d never lived without cataracts, so I had nothing to miss. This was just how I lived, and while I could be jealous of other people seeing things on a bright day or not needing eye drops, I didn’t really imagine how much of an impact removing my cataracts would have.

When I was 20, my doctor mentioned the possibility of surgery. This was the first time it was my choice. I held a level of frustration about everything tied to my cataracts. Glasses, eye drops and check-ins were all a drain of time and money — especially the glasses, which would typically cost several hundred dollars after insurance.

Financial burden aside, my vision was the biggest problem I’d faced in my entire life, but it was one that had become just another part of my day. I’d feel hungry, so I’d eat. I’d feel tired, so I’d sleep. I’d be unable to read a sentence on a page, so I’d wipe my glasses and take some stinging eye drops that needed monthly refills. It felt like getting rid of my cataracts would change everything, so I went forward with the surgery.

My mother was still somewhat hesitant, though she supported my choice. “I really thought, ‘I sure hope that you do have a significant improvement,’” she said. “I knew, of course, you’d get more light in your eye; I just wasn’t sure how… I wasn’t sure how much improvement you’d get from that.”

The surgery took two weeks — first, my right eye, then two weeks to heal, and then my left. I was awake for both, and I doubt I’ll ever experience anything similar again. Each time, I was given an anesthetic, a numbing agent and anti-anxiety medication. I didn’t feel much of an impact from the last one. I suppose there’s a limit on what you can do to make watching a knife cut open your eye less stressful.

My head was clamped to the hospital bed, my eye trapped in a brace to keep it steady, block me from blinking or flinching, and ensure good visibility for the doctors. Then it started. My vision during the surgery got progressively worse. The numbing agent blocked out my ability to see fine details, and once the knife went in and they removed my clouded lens, everything except brightness was gone. Things became a bit clearer once the new silicone lens went in, but only barely. Then, the surgery was done. I was given a bandage to keep on for the next few days while my eye healed, so there was a bit of a wait before I got to see the fruits of my decision.

The first thing I noticed after removing my bandage was my jeans. Blue denim, except it wasn’t just blue anymore. I could see browns, whites and a texture of threads I’d never distinguished before. All these colors had been sitting on my leg, just waiting to surprise me. It wasn’t just my jeans. A wooden table? Now I could see the grain. Reds were redder, blues were bluer. It was incredible.

“It was very fun seeing you afterwards when you had your patches off from your second surgery, just saying, ‘Mom, it’s so great. I just love being able to see more detail, more colors.’ You were just very happy. It was very successful,” said Gillian.

Best of all, I didn’t need to rely on eye drops or glasses any longer — I was finally free.

A year later, I can’t even picture what the world used to look like. I remember things as if I was seeing them now. I can consciously remember how I thought about my sight — I couldn’t exactly write about it otherwise — but the actual images? Those are gone. I can’t help but feel a strange sense of loss at that. For 20 years, I lived with cataracts. They defined me; my lifestyle was built around them. Now they’re just… gone as if they never existed. I don’t miss my cataracts, but I miss the status of having them — that special feeling of being “the kid with glasses.”

It makes me wonder about other people born with similar conditions. Eye problems, hearing issues and so on. Is there some deep aspect of human nature where we take our flaws and unconsciously build ourselves around them? I think I’ll settle for something simple. I’m glad my cataracts are gone.

Did I lose some part of my past self in the process? I don’t care — it was worth it.